Application of The Healthy Migrant Theory to Maternal Morbidity and Mortality Data in Ohio

Abstract

BACKGROUND: The Healthy Migrant Theory is a phenomenon describing a protective effect regarding specific health outcomes when a person of color is born outside of the U.S. Previous literature has focused on the application of this theory to infant outcomes, leaving its application to maternal outcomes mostly unstudied. The objective of this research is to determine whether the Healthy Migrant Theory holds true to maternal morbidity in the Ohio population. METHODS: Birth record data from the Ohio Department of Health was analyzed from 2015-2020 that included mothers identifying as White or Black and data where country of birth was available (n=717,300). Mothers were grouped by race and nationality. Maternal morbidity and socioeconomic status (SES) were analyzed. One-way ANOVA was used to examine associations between SES and number of maternal morbidity events. Binary logistic regression models were developed to examine the relationships among race, nationality, and occurrence of maternal morbidity events. Interaction between race and nationality was also evaluated. RESULTS: Among black mothers, nationality was significantly associated with the likelihood of any maternal morbidity event occurring (OR= 1.659; 95% CI= 1.534, 1.795; p< 0.001), with foreign-born mothers having about 1.66 times greater odds of having a maternal morbidity event. This relationship persisted after adjusting for SES. No statistical difference in low SES indicators was found between foreign-born Black mothers and US-born Black mothers (p= 0.349, 95% CI= -0.007, 0.030). DISCUSSION: Our findings appear to contradict the Healthy Migrant Theory. More research regarding treatment and outcomes of foreign-born Black mothers must be implemented to better understand the nuances of the application of this theory to maternal outcomes. Caution should be taken when comparing infant and maternal outcomes and interventions since they may not be as closely connected as previously thought. Limitations of this project include inaccuracies in data collection from birth certificates, limited morbidity variables, and lack of stratification based on country of origin.